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Do hereb:;" certify that I ha-\-e -revieh-ed the
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attached Hazardous Materials business. plan
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for
CH/JIZ7T/Z 14cJ<:J9IT/c7¿ ¿!IF 7?Ælkf/1fFI.t"¿n-
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(name of business)
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and that it along with the attached additions
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or corrections constitute a complete and correct
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CfT}! of BÄKERSFIELD:
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Stlndl~d Businrss ~ HAZARPOUS MATERI ALS· J:NV~NTé?RY'
~¿; N}:J N -or R A DES E C R E-,T- S "" _ PI"t 1_ of _I
~~¿~~i~~: N~;~~5~;;;'~;:r-n,: dF ß...~AS"AJ'I')"~:::=s:~ME:~;;~·7'ß::::;g~~r~~;~·~ ~¿.~.~- .~.... E OF 'TIrtŠ ~~JL!.TY:-.,
CITY. ZIP: /?A9/t.f/1,!FIf"to... Cd, 5:7.70'7. CITY, ZIP: ~~, G~~ .. . ." ...... N_~. :~D B~:_~Š_T;L_!~_~s_Ng_~: ~_~R_ _ _
PHONE II: f1¿'-;-j''7y-/..x'crb PHONE .: - z.."_. .y:;. . _
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;¡ BUSINESS NAI'1E Clif\¡:¡T[~OSPITf1L OF Bf-\I<EH:;FlELD
LOCATION 5201 W~ LANE
10 NUMBER·ZI5-ØØØ-0ØllZ9
He H(7ZARO RA"fING r
1. OVERVIEI,J
LAST CHANGE 09/16/88 BY ESTER
JURIS CODE 215-0Ø9 JURIS BAKERSFIELD STATION 09
MAP PAGE 123 GRID 150 FACILITY UNITS 1 HAZARD RATING Z
RESPONSE SUMMARY
ZASEC 4) BASIC FIRST AID/CPR/USE OF FIRE EXTINGUISHERS. NURSING STAFF ON
DUTY ARE TRAINED IN CPR AND ·FIRST AID. ALL STAFF HAS TRAINED IN
USE OF FIRE EXTINGUISHERS.
EMERGENCY CONTACTS 2A SEC Z)
ROGER E. PHELPS - 398-1800 OR 398-7224
JONATHAN GARBER - 398-1800 OR 589-5637
UtILI TY:'SHtJTOFFS ZA SEC 3) A) GAS" - OUTSIDE CENTRAL STORE "ROOM sE CORNER
DOCK AREA '8) ELECTRICAL - BETWEEN. MAINTENANCE & MECHANICAL "ROOMS AND lOADING
DOCK C) ~ATER - EQUIPMENT ROOM NEXT TO FIRE RISER BY FIRE LINE 0) SPECIAL - ,.
DIESEL FUEL TANK (1Ø00 GAL> E) LOCK BOX - MAINTENANCE OFFICE (œJ .J1lJII RIDE () :9 :',
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ft~µHr/lf ¡¡r-o ~~r.ro~/r?lIY Nt:>T7Fý $~r.
< NO INFORMATION RECORDED FOR THIS SECTION>
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12122188 10: 37
MATERIAL SAFETY DATA SYSTEMS. INC. (80S) 648-680Ø '
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BUSH-lESS Nf1ME CH(-\tTr&m¡PITAL OF 13liKEHSFIELD
LOCiHJOf\! 52~}1--W'''rn:.~-~_
3. HAZ' MAT TRf\HiING SUMMA;~~
m N.=FI Z 15-ØØØ'·,Ø01 ZZ9
t -H HAZARci RATING Z
UiST CHANGE I I~' In 8';' ~6M '?/~J3¿~
"f"" All/A/¡ J µOF¡JLZOI3IPl;?S-,. ~b/"V77;?";I-",µ6.-.s ~f" roÄ,Ø /..¿ IrTn"2/P~.I ;""I"'?rr,. ,,n;U
If 4V;(1.llqt/¿'.F /N olr~~~;n 0;::' J'r/"brr S'1!.nv/¿·r.r e>rrt~r"
A/rev f'T;f;fPF ArC c:,,.u~_r,,.;rrs:.~ 1M ~,....~¡? S-r.Ø/D/-'S",
< NO INFORMATION RECORDED FOR THIS SECTION>
1""'1 f i;;J S" ~ /1--e derl-Q~ C.ø,-, E"!7 j7ë:) / µO/~ 0 'ldP;-7'?<-1 r _ ¡y /I,-n/Q¿ v-r ø / H 771' £
VSE" S/.?;P'e:;-T7 /-f7,;e.A-rh/ ~v-;---'-L en u ~;I-,p ~:t:S'r f'771Fr /"?.r......./Jr...'j' AÞ£ IAI:5r./Zvur~
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Foi'h'J" K~pr-t:!v/f':Ñ ;4?.f¿J...f" /'ð6",
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4. LOCAL EMERGENCY MEDICAL ASSISTANCE
LAST CHANGE 09/16/8a BY ESTER
ZA SEe 5) MERCY HOSPITAL - 2215 TRUXTUN AVE - 327-3371
MEMORIAL -420 34TH ST - 327-1792
EMERGENCY SITUATIONS BEYOND SCOPE OF BASIC FIRST AID OR POSSIBLE
CPR WOULD BE HANDLËD BY CALLING 911 AND TRANPORïING PATIENT( S) TO
NEAREST Z4HR EMERGENCY ROOM WITH SPACE AVAILABLE.
PAGE Z
12/22188 10: TI .
MATERH\L SAFETY DATA SYSTEMS, INC. (805) 648-6800
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BUSINESS WiME Clh::RYEAOSPITAL- OF i3AKERSFTELlJ
LOCATION 5201 W~E LANE .
FACILITY UNIT 01
TO I\IU."-." R Z 1 ~J,-ØØ(Ï)-Ø01 229
H _ HAZARD RATING Z
A. OVERALL HAZARDOUS MATERIALS INVENTORY
LAST CHANGE 09/16/88 BY ESTER
ID
TYPE NAME
LOCATION
CONTAINMENT·
MAX AMT UNIT HAZARD
USE
PURE #2 DIESEL FUEL
20FT S GENERATOR E SIDE UNDERGROUND TANKS
10 PERCENT COMPONENTS
1179.01 100.0 DIESEL FUEL NO.2
1000 GAL MODERATE
FUEL
. HAZARD LIST
MODERATE
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B. .FIRE PROTECTION / WATER SUPPLIES
LAST CHANGE 09/16/08 BY ESTER
3A SEC 4) FULLY SPRINKLERED FACILITY INCLUDING FIVE EXTERIOR FIRE HYDRANTS
FOR FIRE PROTECTION.
3A SEC 5) FIRE HYDRANT DUE W OF END OF 5 WIND AT GRISSOM.
PAGE .3
1 Z/ZZ/88 10: 37
MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800
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BUSINESS NAME CH(1RTøHOSPITAL OF BAKERSFIELD
LOCATION "5201 WHITE LANE
10 N~ER Zì5-ØØØ-ØØ1ZZ9
,HIGH HAZARD RATING Z
O. EMPLOYEE NOTIFICATION I EVACUATION
LAST CHANGE 09/16/88 BY ESTER
3A SEC Z> WE WOULD BE NOTIFIED OF Ii LEAK VIA ALARM AT NURSES STATION FROM
PROBES IN ENCLOSURES. THE TANK, BEING OUTSIDE, WOULD NOT REQUIRE
EVACUATION OF OUR FACILITY. DEPENDING ON THE SEVERITY OF THE LEAK
WE WOULD BARRI CADE OFF THE AREA AROUND THE TANK ;'TO PREVENT ACCESS
AND PLACE SIGNS AS APPROPRIATE IE. "NO SMOKING".
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E. MI,ÜGATION ¡ PREVENTION' 1 ABATEMENT
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LAST CHANGE 09/16/B8 BY ESTER --
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3A SEe T) DI ESEL FUEL TANK - TANK AND PIPING IS DOUBLE WALLED WI:TH LEAK
DETECTION MONITOR PROBES AND ALARMS. A LIQUID LEVEL INDICATOR
PROVIDES CONSTANT DIGITAL READOUT IN INCHES OF FUEL IN TANK.
WE MAINTAIN 0' MINIMU~OF_~~ALLONS OF #Z DIESEL ~T ALL TIMES.
, BJO
"
PAGE 4
1 ZIZZí88 '/0: 37
MATERIAL ~AFETY DATA SYSTEMS, INC. (005) 648-6800;'
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BAKERSFIELD CITY FIRE DEPAR~
2130"G" STREET
BÀKERSFIELD,. CA 93301
(805) 326-3979 J ;B -ISO
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f\tECEJVED
APR 1 1988
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HAZ'ARDOUS MATERI'ALS
BUSINESS PLAN AS A WHOLE
FORM 2A
, ,
INSTRUCTIONS:
".
1. To avoid further attionj täturn this form by
2. TYPE/PRINT ANSWERS IN ENGLISH. ' ,
3. Answer the questions below for the business
4. Be'as brief and concise as possible. -
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as a whole.'
SECTION 1: BUSINESS IDENTIFICATION DATA
A. BUSINESS NAME: CI-I~JIl'rER I-!05'PITAL ðF /3AItEIZSFIEL.O
B. LOCATION / STREET ADDRESS: s-';Jôd ¿V/~/77: LA;1~E
CITY: ßIJItr:nSF/ifLO
ZIP: 1:?Jo 9
BUS. PHONE: f..3'ðS} 3' 9l?-IP~
SECTION 2: EMERGENCY NOTIFICATIONS
In case of án emergency involving the release or threatened release of a
hazardous material, call 911 and 1-800-852-7550 or_.1-916-427~4341. This will notify'
your local fire department and the State Office of Emergency Services as required by
law.
E~PLOYEES TO NOTIFY IN CASE OF E~ERGENCY:
NA~AND TITLE . DUø BUS. HRS.
A. rJ ~£ R E_ Ph~L.¡4f -/:)JÆS'"~ffd;;- Ph#?ð q~~
$'1:"". /,.// e-e-:J
B. dðN'J:aT.Ift#N (.f-¿)I1L?F/t -A'O""'Iµ/S77tH~ p.r(39X¡1J?n:j
AFTE~tJS. HRS.
Ph# ,?"ðj- 9'ç-7~;;2.~
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Ph# RØif~-66:37
SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE
A' NAT. GAS/PROPANE: O~ÎS IDr CrN'r_i. J"7"rs",'- 1Za_ ðN (S1:577'YH~t::i:tji~"':~Lk[Oðelf. "nrA)
B. ELECTR~~Af:~ RtJo~ -'lr"Tû~..~__~.:A'_rr~~t:',':.S~ ~~_~'·:'f.~~~I<~-~71:?:,ð:;'#Å.
C, WATER: il:Jiu¿t,KJ-<",rNT J?Qr:,~. f\{§df;[.-:,r~_Elt?£-::.Rl~ l?:pA/o;:Ii::L~F' t$./2/'SSð.- ~"Þml' ~/""
D. SPECIAL: DIEszt ¡=vu T1J¿I.J", v-- t;.,) ~~_.K ,,,," SO(;TI1:~,6" G.r:_.."..AH'If:IA. ~ ~,_t; ~~
E. LOCK BOX: ~,/ ~O IF. YES, LOCATION:.HA/~NAN("Æ:ðF":'cc _ D"t:ICk r"..,,-n., (i-A:Pr) R v S7;A1FF
_ C7 \. " . '. . . ',Ñ""Jc é:ûéJ(
IF YES, DOES IT CONTAIX SITE PLANS?¡f@ / ~O ~SDSS? ~'l NO
FLOOR PLANS? ~ / XO KEYS? ~ / ~O
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SECTION 4: PRIVATE RESPONSE TEA~ FOR BUSINESS AS A WHOLE
BASIC F'ì/l$, A/n::J/cP/2 /v.u or FNU &.K"'/~ð~NrAHn~
/l/tNtSI¡..#(T S'7:lI1;:'F ð_ ,ø"'F"")' """'I: TI'ZIf1'Mt~ /,M C;""A A,N"P ;::'*,ns r- /11"(;1..
All $'7AfFF Al'tr r/1,IJIµ~'-' /~ ~J"£ 0,.-" Fo'~ ,S"¿leÏlµd-~"'J"~£Ar,
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SECTION 5: LOCAL EMERGENCY ~EDICAL ASSISTANCE FOR YO~~ BUSINESS AS A WHOLE
::/Ii / ~EIZC y /"¡ð~/"rAL, - c ~orr:s-;-
:# ,1... /JA/( £n.sFlel.þ /"fé./"u/UH¿ - ,JU:""" e~~
~'V"6~1 8r.~- ~~z of gAr'c ¡:::""rr¡- ""'-Þ ."'" ".,_r#nll' ~~A e-......eAtP
F,;If&'" 64 ~c)" :r I _
.... #"µ~ 'i'// A~ T/l",.~r"."''f7~ P""17C_~ a;) 7'Z> ¡AIC~~r-;- -;. ~ ~^
IJ r ~.......e.ø If)' .....AI ,
1"''''''~A6&,u~y ~ """rN SO;"""'#: A~J'H4..~II#-r"
SECTION 6: " EMPLOYEE. TRAINING
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E~PLOYERS ARE REQUIRED TO HAVE A ~ROGRAM,W~ICH ?ROVID~S EMPLOYEES WITH INITIAL AXD
REFRESHER TRAINING IN THE FOLLOWING AREAS ."
" "
CIRCLE YES OR NO IXITIAL " ,
A. ~ETHODS FOR SAFE HANDLING OF HAZARDOUS
!tATERIALS:., ."",.,.. ,'.."" ,"..".",."........,. @ NO
B. PROCEDURES FOR COORDINATING ACTIVITIES
WITH RESPONSE AGENCIES:,...."...,.".,.,..".", ~ NO
C. PROPER USE OF SAFETY EQUIPMENT:. , . , , . . . . . , , . . . . .. m NO
D. E~ERGENCY EVACUATION PROCEDURES: . , . . . . . . . . , . , , . . , . NO
E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS:,.,.... S NO
..... '.
REFRESHER
@]> NO
m' XO
"E NO
E,S XO
YE NO
SECTION 7: HAZARDOUS MATERIAL
C¡RCLE. YES ~,;,NO - NONE, " -
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DOES YOUR BUSINESS HANDLE 'HAZARDOUS MATERIAL I)¡ QlJ'ANTITIÈS LES,S THAN 300por;XDS OF A
SOLID, 35GALL~NS ,OF A LIQlJI,D., OR 2,00 ClJBI~ FEET OF A .cmrPRESSED, G~S: , .,,',. '. <ys> NO
'\. . ~ ~ ". , . , -, \ '\., - '-.. \ ... ~. _! ': ',...
I. TðM.A-TMAH ~AJAA£n. , certify that the above information is accurate.
I understand that this information will be used to fulfill my firm's obligations under
the new California Health and Safety code on Hazardous Materials (Div. 20 Chapter 6.95
Sec",_~,~?,~~B:.~:r.5~~~:¿J, ~pd, "t~~..t inacc~~"at~ information const~ :~,tes perjury.
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'"7-/0/-fINI37'RATOrz DATE 3--30-88
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BAKERSFIELD CITY FIRE DEPAR~IEXT
2130 "G" STREET
-BAKERSFIELD, CA 93301
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BUSINESS ¡\A)1E: Chatte.r \-fosp;tc.d
ID#
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BUSINESS PLAN
SINGLE FACILITY UNIT
FORM 3A
INSTRUCTIONS
1. To a~oid .further action. this form must be returned b :
2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. ' Y
3. Answer the questions below for THE FACILITY UXIT LISTED BELOW
4. Be as BRIEF and CONCISE as possible. '
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'FACILITY UNIT ,Nk'Œ: C /iHí/nn:rz 1¡ib~/:;rA¿ ðr
SECTION 1 VITI ,\, Bð~Ú'Z~p¡r¿ .
( : i'l GATION, PREVENTION. ABATEME~l PROCEDtJRES -
'V/ff£,¿ FÚfL T/;RI< - -7Ã'¡4~ /IN?? ¡Ø/~/µ6 '.~ (?ðUßt:-¿
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/lLÆr~f %n- ß~ 771~ f ~;//~, ;ø--¿/ (þu/A:? ¿£-Ve-L
/ A/-t:71 ~~ ,r<J ;z>V?;¡;"'!.J'" ~.rrA.N-.;Þ ¡(i71 &. 7?/f¿ /2rAi'Vé7<'Y- 4I';V
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d? 6' ~/--<- &µ.y øF-#- t?-- 6?/s::src. ~A9¿¿ 'T7~d-
FACILITY UNIT#
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SECTION 2: NOTIFICATION A~~ EVACUATION'PROCEDLKES AT THISL~IT O\~Y,
.L~ ((¿Ir::>w~~~' K~ "AkiV7A'Uc7 ðP A ¿J?#k· .////P.,/;'-4P"~'
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or? V7~ ~~/? h'1"'~~ v::?I~¿/"L ~ ~~$:~,.....::r- 4L~$J'"
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S'2CT10~ 3: H;\7.:\RD01;S yfAT?-RIALS FOR THIS Tj~nì OXT.Y
A, Does this Fi1cility [nit ~onti1:'n r1az:1rdous :-íc1te!'L1L~')"",. 6Y :;0
If YES, see B.
If NO, continu~ with SECìIO~ 4.
B. Are any of the hazardous materials a bòna fide Tr~de Secret YES €E)
,-/
If No, complete a separate hazardous materials inventory
form marked: ~OX-TRADE SECRETS OXLY (white form #4A-l)
If Yes, ~omplete a hazardous materials inventory for~ ma~ked:
TRADE SECRETS O~LY (yellow for!11 #4A-2) in addition to the non-trade
secr~t for~. List only the trade secrets ori form' 4A-2.
SECTION 4: PRIVATE FIRE PROTECTTOX
ßay,~¡?ro-~ lr,n..r.o "FH.t:/¿/ '/y /µ~¿".(?/""'~ (6') T/vt:.
£~ft-l ð/L .¡Z; /1-£ ,1:17 PI'A//-J:;"J ,
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,SECTION 5: LOCATION OF ~'¡ATERSGPPLY FOR USE BY ÐŒRGENCYRESPO~ERS ,-
t;)v-r W£5r~$(?i.r::"; e/-#:?, ðP $oo"T'7lf/ W/µ(;- A1y-&tlrl<:J~'
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SECTION' 6: 'LOCATTO~ OF L'lTLITY SffiJT-OFFS AT THIS bh'r ONLY',
A. :\Xf. GAS:PROPA~E-:' "","'" '\
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B. ELECTRICAL:
0_.. µ,~y 7V ./"?H/µY?~~(!'"...-;£ .5/ØyO ð~ S:~$~
/ µ r ¿£:¿-"T/l¡ ¿-~H·l. /&er=-', .pp r _JT/Z/1?-,¿'S!' t!I"""
'$I/?'~ ~p F~/ ¿" 7y '" ;J'tf,!Z- ~ áóo~, óYF SV7f1 '
1;)G~ 'K.'" . CA~d"''¿ ~".:) ð¿1-l s-F7H""'P t:,HPnY., C~ ~) .
C. WATER: ',.. .' I?t?- " ~ øF $~ r;..¿~e.£
../"'t z ~ Jh;rN ~ £. /Z- 3 J:?o'csY, "
IN -'" . ð _~ Z,µT/U,,",..n:~ t: <t~ ~4 ,
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6~~.n~ LÁ~ra-J ~ ~pp ~Þ"V?Z.y é6%~ ~
0, SP¡::C:AL:
¡:, LOCK BO'\@ /:\0 . IF YES, LOC\TIO~>
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T r- YES~S TTE' P~.~:;S') ?E:; /éJ;> ~Sf)S:.;'; "{:::'J "(fð:>
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FORM 4A-J
NON-TRADE SECRETS
IIAZARDOUS MATER I ALS' I NVENTORV
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Cj..:fA/2TZ/'Z /-frJ~/TAl Or
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O"NRR NAME: C/+A1I""TJ:/7 ,/f-?Z~/t!:A~
ADDRESS: /)"77 .,qvü?r/2/?1/ <:7:
CITY. ZIP: ~Å/ ~~ðO~./-1 AlL
PIIONE ,: 1-,1?Zð - í?~/- 9L/ð:J'
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AFTER DUS IIRS: J&.V'}",f'-7~;).Y
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